Employment status – long-term | HMRC, NHS pension and employee status

This FAQ is from the perspective of being a GP locum in the same practice for a 'long time', rather than about choosing working as a GP locum as part of your career portfolio.

A long-term locum post at a practice often starts off as a short-term venture, but with significant recruitment problems in general practice at the moment, it's likely the practice will want to hold on to you and keep you coming back.

Alternatively, your stint at the practice could have begun very much with the long term in mind. Either way, the longer you're at the practice, the more your role will slowly change from that of ad-hoc short-term locum to being part of the practice team. As this process goes on, not only will your significance within the practice develop in the eyes of patients and staff, but certain regulatory factors will also come in to play.

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There are four areas that need careful consideration the longer you work for the same practice.

Tax purposes

  • The decision of whether you're self-employed or an employee for tax purposes is ultimately down to HMRC, and depends upon factors such as if you run your business for yourself and take responsibility for its success or failure, work for several practices at the same time, and you can decide how, where and when you do your work etc. More details are available on the GOV.UK website.
  • Or you may have already set yourself up as your own limited company.
  • Use HMRC's employment indicator tool to give you a clearer understanding of your tax status.
Our advice is to ask an accountant if you're unsure in any way.

Employment law

Although your work at the practice may have begun with you being self-employed, or employed by an agency, certain factors in the way you work with the practice may, over the duration, inadvertently give rise to you becoming an employee of that practice in terms of employment law.

If you're employed by the practice, you can have access to certain rights such as Statutory Sick Pay, protection against unfair dismissal, the right to request flexible working and quite a few other rights.

Employees have a contract, and this can be written or verbal. Consider adding this to your own T&Cs.

NB you can now set your T&Cs online in NASGP's LocumDeck.

If you're doing any sort of locum work, you'll definitely need your own personalised Terms and Conditions that will protect both you and the practice you're working for. NASGP's model T&Cs has been specifically developed for us by a specialist employme law firm, and allows you to not only fully adopt all its recommendations, but also to add any necessary clauses, and tailor it to suit your personal needs.

  • cancellation policy
  • employer's pension contributions
  • legal employment status
  • tax status
  • duties
  • payment terms

As an NASGP member, go to your T&Cs generator, choose your settings and then save. You'll then be given a unique link "View my TCs" which will automatically be added to your automated invoices and session request emails, or you can paste the link into your own website.

As an added bonus, you can update your T&Cs as often as you like, with each change being saved in an archive accessible by your practices for extra confidence.

What makes you an employee for the purposes of employment law can depend on about 15 different factors.

To protect both the GP and the practice, we advise having a conversation about your duties with the practice manager sooner rather than later, and taking any necessary legal advice, to make sure both parties are clear about your contractual status.

Long-term status for the purposes of NHS pensions

We have a separate FAQ on this:

There are three active formal definitions of a locum GP, depending on your aspect. They are not exclusive i.e. being one does not exclude another.

  1. Employment law
  2. Tax status with HMRC
  3. NHS pension scheme

This advice deals exclusively with the NHS pension scheme definition.

From advice direct to NASGP from NHSBA:

Locums cannot be classed as Locums [in respect the the NHS pension scheme] if they work at a practice for more than 6 months, however even if they are at a practice for more than 6 months they can remain as self employed contractors ie they do not have to go on the payroll and the practice do not have to offer them a contract of service. They would still invoice the practice for sessions/shifts done and then the GP SOLO form would be completed and sent instead of the Locum forms.

If a Locum works at a practice for more than 6 months then they should no longer complete locum forms A & B but should then complete SOLO forms for any period beyond the 6 months. They will then be classed as a Type 2 practitioner and this is better for them in pension terms because they will be covered for death in service 24/7 whereas Locums are only covered whilst working.

Ensuring a locum GP is a self-employed contractor, not an employee

See also

If you locum at a GP practice for more than 6 months then you can no longer be classed as a locum (for NHS superannuation purposes) in that practice, and would have to become a Type 2 GP.

According to the NHSBA Locum Factsheet (September 2016):

After six months of working in the same practice:

"You can still work under a contract for services arrangement; your surgery is not legally obliged to employ you under a contract of service."

And according to the NHSBA Form GP SOLO (April 2016):

"[Form GP SOLO applies] to NHSPS Employing Authorities including OOH Providers and CCGs who engage the services of GPs on a self-employed/fee-based/contract for services arrangement."

You can see if the practice you're working in is an NHSPS Employing Authority.

You will then be able to pension 100% of the fee paid as opposed to 90%.

Mission creep

There are as many reasons for working as a locum GP as there are GP locums. Some of us enjoy working in lots of different practices: spreading best practice; supporting practices in difficulty; offering patients a fresh approach to their care; a second opinion, and focusing on direct patient contact. Whereas others love continuity of care, building therapeutic relationships with patients and getting more involved with the running of the practice on a day-to-day basis.

Often, if just covering a few sessions for a practice, one would expect to simply deal with the patients seen in surgery that day and any necessary paperwork resulting from those consultations (such as writing referral letters etc), and this is what one would generally be charging the practice for.

If working again at that practice over the coming weeks and months, one would expect to results of investigations, tests and referrals to start returning to the practice. These results and correspondence would either go back to that patient's usual GP (if there is one) or one of the other practice GPs. But if no-one is available, and especially if you requested these tests, it's quite likely that these results will be given to you to deal with.

Of course, this may well be all part of what you really value in working as a GP, but it does take time beyond that which you may have initially agreed, and could start to eat into the time you'd normally allocate to your other roles. By being such an obliging GP, no doubt too you could soon become the go-to GP who all the staff find so helpful, and find your workload rising exponentially - greatly increasing your value to the practice, but also having a potentially huge impact on your work-life balance.

Set boundaries

All of this is quite containable to begin with, but if not controlled early on could just get out of hand. Our advice is, if the same level of workload is set to continue, after a certain amount of time and/or workload e.g.

  • two sessions a week for six weeks, or
  • six sessions a week for two weeks

To either

  • negotiate more pay, pro-rata, or
  • reduce the number of patients seen during a session and replace that patient-contact time with administration time.
Consider adding this to your own T&Cs.

NB you can now set your T&Cs online in NASGP's LocumDeck.

If you're doing any sort of locum work, you'll definitely need your own personalised Terms and Conditions that will protect both you and the practice you're working for. NASGP's model T&Cs has been specifically developed for us by a specialist employme law firm, and allows you to not only fully adopt all its recommendations, but also to add any necessary clauses, and tailor it to suit your personal needs.

  • cancellation policy
  • employer's pension contributions
  • legal employment status
  • tax status
  • duties
  • payment terms

As an NASGP member, go to your T&Cs generator, choose your settings and then save. You'll then be given a unique link "View my TCs" which will automatically be added to your automated invoices and session request emails, or you can paste the link into your own website.

As an added bonus, you can update your T&Cs as often as you like, with each change being saved in an archive accessible by your practices for extra confidence.

It's safe to say that as GPs, we often have a great sense of duty to practices and can find it exceptionally hard to refuse help when our input is genuinely needed. But if we neglect to contain the expectations of practices to a sustainable level that each of us can comfortably manage, it could just end up with us becoming the patient. And that's of no use to anyone.

Listen to our podcast on long-term locuming

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